Adolescent Medicine Flashcards

Question

What is the most common solid breast mass in an adolescent girl?

Answer 1

Answer Fibroadenoma Explanation Fibroadenomas represent a benign mix of stromal elements, ducts, and acini. The masses are firm, painless, rubbery in character, and distinct from the rest of the breast. They are typically asymptomatic but can cause discomfort for a few days prior to onset of menses; however, they do not usually regress or change with hormonal fluctuations. They tend to be in the upper outer quadrant of the breast, and most range in size from 2–3 cm. Simply observe asymptomatic solid breast masses that are < 3 cm. Perform excisional biopsy on persistent, larger, or suspicious lesions.

Answer 2

Normal pubertal development Explanation Primary amenorrhea is defined as the absence of menses: by 15 years of age with the presence of normal secondary sexual development, by 13 years of age with complete absence of secondary sexual characteristics, or > 3 years after onset of thelarche. This patient is only 14 years of age and therefore does not meet the criteria for primary amenorrhea. She is showing normal development and has a normal BMI.

Answer 3

Answer Prostaglandin production Explanation Prostaglandin production causes vasoconstriction and muscular contractions. In addition to the antiinflammatory and analgesic properties of NSAIDs, they decrease menstrual cramping by inhibiting prostaglandin synthesis. Combined oral contraceptives—which inhibit ovulation, leading to an atrophic endometrium, decreased menstrual flow, and decreased prostaglandin release—are often effective in adolescents who do not improve with NSAIDs.

Answer 4

Pregnancy Explanation Secondary amenorrhea is the absence of menses for > 3 months in adolescents who previously had regular menstrual cycles or the absence of menses for 6 months in those who had irregular cycles. Pregnancy is the most common cause of secondary amenorrhea. Pregnancy can also be the cause of primary amenorrhea (no menses to 15 years of age), but this is rare.

Answer 5

Answer Spermatocele Explanation A spermatocele is a retention cyst of the epididymis containing spermatozoa and located in the efferent ductal system. It presents as a smooth, cystic, mobile nodule above and posterior to the testis. Spermatoceles do not change in size with the Valsalva maneuver and sometimes transilluminate. Typically, they do not affect fertility or require therapy.

Answer 6

Answer Testicular enlargement Explanation Male sexual development generally begins at an average age of 11.6 years (range of 9.5–13.7 years of age), with the 1st physical sign of puberty being testicular enlargement. Onset of puberty occurs, on average, 6 months earlier for Black boys than for White boys and Hispanic boys. For boys, puberty usually lasts an average of 5 years (range 3–6 years).

Answer 7

Bulimia nervosa (BN) Explanation BN affects 2–3% females in the U.S. and < 1% of boys. Patients with BN have recurrent episodes of binge eating during which they feel that they “lack control” of their eating behavior. Due to persistent concern with their body shape/weight, they regularly resort to self-induced vomiting, diuretics and/or laxatives, fasting, and overexercising to prevent weight gain. Signs and symptoms of self-induced vomiting include bilateral painless parotid gland swelling, loss of tooth enamel, metabolic alkalosis, calluses and lacerations on the dorsum of the hands (Russell sign), and soft palate petechiae.

Answer 8

Answer Sexually transmitted infections such as chlamydia or gonorrhea Explanation In an adolescent, epididymitis is often caused by Chlamydia trachomatis or Neisseria gonorrhoeae or both. Infections of Escherichia coli and other bowel flora, contracted via unprotected anal intercourse, can also cause epididymitis. Patients present with subacute onset of pain in the hemiscrotum, increased urinary frequency, dysuria, urethral discharge, and fever. The epididymis is swollen and tender on physical examination. Unlike testicular torsion, in epididymitis, the cremasteric reflex is present, the testicle lies in the normal position, and pain is often relieved by elevation of the testis (Prehn sign). Urinalysis, Gram stain, urine NAATs, and cultures of urethral discharge are typically diagnostic. In contrast to testicular torsion, in epididymitis, a radionuclide scan and Doppler ultrasound demonstrate increased perfusion and flow. Treat the patient and partner(s) with the appropriate antibiotic(s).

Answer 9

Onset of breast budding Explanation In most females, the onset of breast budding (thelarche) is the 1st physical sign of puberty. In the U.S., puberty begins at a mean age of 10 years in White girls and 6 months earlier in Hispanic girls and Black girls. Generally, Asian girls have the latest onset of puberty. Puberty for girls generally lasts an average of 4 years (range of 1.5–8 years).

Answer 10

Urethritis—most likely due to Chlamydia trachomatis Explanation Neisseria gonorrhoeae and Chlamydia trachomatis are the most common causes of urethritis. On Gram stain of the urethral discharge, the presence of ≥ 2 WBCs without any organisms is consistent with nongonococcal urethritis—most likely due to Chlamydia trachomatis. Gonococcal urethritis is diagnosed by the presence of gram-negative intracellular or extracellular diplococci in the urethral exudate. Treatment for urethritis due to Chlamydia trachomatis is doxycycline 100 mg orally 2×/day for 7 days; azithromycin 1 g orally in a single dose is an alternative treatment, keeping in mind that microbiologic treatment failure among men is higher for azithromycin than for doxycycline.

Answer 11

Answer C-section Explanation In adolescents with genital HSV lesions or prodromal HSV symptoms at the time of labor, cesarean delivery is recommended. The major complication of maternal HSV infection during delivery is transmission to the newborn. Neonatal infection can result in serious morbidity and mortality; the risk of transmitting HSV from a mother with primary genital infection to her baby at or near delivery is very high (40–45%). Therefore, women presenting with lesions at the time of delivery should have a C-section. Women without prodromal or clinical signs and symptoms of herpes at delivery can deliver vaginally.

Answer 12

Answer Long-acting reversible contraception (LARC) Explanation LARC, which includes subdermal progesterone implants and IUDs, is recommended by the AAP as 1st line contraception in sexually active adolescent females. It is the most effective form of birth control at over 99%. Worry about the risk of introducing or causing pelvic inflammatory disease (PID) with an IUD has been shown to be unfounded, with equal rates of PID in females with and without IUDs in place. Male condoms are the most effective method besides abstinence for preventing STIs; recommend them to adolescents even if they are using other forms of birth control.

Answer 13

Herpes simplex Explanation Do not be dissuaded by the presence of lymphadenopathy, cervical motion tenderness, and vaginal discharge—all 3 of these are common with herpes infection, especially the initial herpes infection. The key here is the vesicular lesions that are painful and itchy, which makes syphilis unlikely. Obviously, she can be coinfected with Chlamydia or other STIs, but the vesicles are specific for herpes simplex infection.

Answer 14

Pituitary adenoma Explanation A pituitary lactotroph adenoma (i.e., prolactinoma or prolactin-secreting adenoma) may cause amenorrhea and is often associated with galactorrhea. By definition, a pituitary microadenoma measures < 10 mm; a macroadenoma measures > 10 mm. Most microadenomas do not increase in size, whereas macroadenomas have a significant potential for growth, resulting in visual field defects, headaches, and loss of anterior pituitary function. Bromocriptine, a dopamine agonist, often restores menses and decreases prolactin levels to normal in patients with a microadenoma.

Adolescent Medicine Flashcards

(38 cards)